            <div class="introTour">
                <div id="div-boxTour">
                    <div id="div-tableBox">
                        <div class="logo"></div>
                        <br />
                        <table border="0" width="660px">
                            <tr>
                                <td height="20px" colspan="3">
                                <b><?php echo $name_tour; ?></b>
                                </td>                                
                            </tr>
                            <tr>
                                <td height="30px" width="200px">Full Name</td>
                                <td width="460">
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtFullName"/>
                                </td>
                            </tr>
                            <tr>
                                <td height="30px" >Gender </td>
                                <td >
                                    <input type="radio" style="border: medium none;" value="Male" name="txtGender">
                                    Male &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                    <input type="radio" style="border: medium none;" value="Female" name="txtGender">
                                    Female 
                                </td>
                             </tr>
                            <tr>
                                <td height="30px" >Date of birth </td>
                                <td >
                                    <select name="mm" size="1">
                                        <option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                    &nbsp;&nbsp;&nbsp;&nbsp;
                                       <select name="mm" size="1">
                                        <option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                    &nbsp;&nbsp;&nbsp;&nbsp;
                                       <select name="mm" size="1">
                                        <option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                </td>
                             </tr>
                            <tr>
                                <td height="30px" >Address </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtAddress"/>
                                </td>
                             </tr>
                            <tr>
                                <td height="30px" >City </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtCity"/>
                                </td>
                             </tr>
                            <tr>
                                <td height="30px" >Country </td>
                                <td >
									<select name="sltCountry">
										<option value = "vietnam">Vietnam</option>
										<option value = "laos">Laos</option>
									</select>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Email  </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtEmail"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Home phone  </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Fax number  </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px">Departure Date  </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Room preference: </td>
                                <td>
                                   <select name="mm" size="1">
                                        <option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                    &nbsp;&nbsp;&nbsp;
                                     <select name="mm" size="1">
                                        <option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px">Date of Tour </td>
                                <td >
                                    <select name="mm" size="1">
											<option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                    &nbsp;&nbsp;&nbsp;&nbsp;
                                       <select name="mm" size="1">
                                        <option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                    &nbsp;&nbsp;&nbsp;&nbsp;
                                       <select name="mm" size="1">
                                        <option value="0">0</option>
                                            <option value="1">1</option>
                                            <option value="2">2</option>
                                            <option value="3">3</option>
                                            <option value="4">4</option>
                                            <option value="5">5</option>
                                            <option value="6">6</option>
                                            <option value="7">7</option>
                                            <option value="8">8</option>
                                            <option value="9">9</option>
                                            <option value="10">10</option>
                                            <option value="11">11</option>
                                            <option value="12">12</option>
                                            <option value="13">13</option>
                                            <option value="14">14</option>
                                            <option value="15">15</option>
                                            <option value="16">16</option>
                                            <option value="17">17</option>
                                            <option value="18">18</option>
                                            <option value="19">19</option>
                                            <option value="20">20</option>
                                    </select>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Name of Airlines </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Flight Ref & Arrival time: </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Request for Visa Arrangement </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Your request to change or modify from this specific tour  </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Number of adults traveling  </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Number of children traveling   </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >Hotel category you prefer </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
                             <tr>
                                <td height="30px" >How did you learn about us? </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
							 <tr>
                                <td height="30px" >Your Comment </td>
                                <td >
                                    <input type="text" style="width: 200px; font-size: 14px;" value="" name="txtContact"/>
                                </td>
                             </tr>
							 <tr>
                                <td height="30px" ></td>
                                <td >
                                </td>
                             </tr>
							 <tr>
                                <td height="30px" ><input class="button" type="submit" name="btnSubmit" value="Send Form"/></td>
                                <td >
                                </td>
                             </tr>
                        </table>
                    </div>
                </div>
            </div>